Concordance between two versions of world health organization/international society of hypertension risk prediction chart and framingham risk score among postmenopausal women in a rural area of Bangladesh

Background: Prevention of cardiovascular disease (CVD) among postmenopausal women with limited resource is a great challenge for a country like Bangladesh. Objectives: This study aimed to evaluate the level of agreement among different risk prediction tools to find out the cost-effective and suitable one that can be applied in a low-resource setting. Methods: This was a cross-sectional study conducted from February through December 2016 among 265 postmenopausal women of 40–70 years age. Data were collected from the outpatient department of a rural health-care center situated in the village Karamtola of Gazipur district, Bangladesh. The CVD risk was estimated using the World Health Organization/International Society of Hypertension (WHO/ISH) “with” and “without” cholesterol risk charts and the Framingham Risk Score (FRS). Concordance among the tools was evaluated using Cohen's kappa (?), prevalence-adjusted bias-adjusted kappa (PABAK), and first-order agreement coefficient (AC1). Results: The “without” cholesterol version showed 79% concordance against the “with” cholesterol and 75.4% concordance against the FRS. In between the WHO/ISH risk charts, slight-to-substantial levels of agreement (? = 0.14, PABAK = 0.58, and AC1 = 0.72; P = 0.023) were observed. With FRS, the “without” cholesterol version showed higher agreement (? = 0.38, fair; PABAK = 0.50, moderate; and AC1 = 0.60, moderate; P = 0.000) compared to “with” cholesterol version (? = 0.13, slight; PABAK = 0.30, fair; and AC1 = 0.44, moderate; P = 0.013). Predictability of CVD risk positive (?10%) cases was similar for both the versions of WHO/ISH risk charts. Conclusion: In a low-resource setting, the “without” cholesterol version of WHO/ISH risk chart is a good option to detect and target the population with high CVD risk.

Central Obesity Plays an Important Role for the Development of Type 2 Diabetes in Bangladeshi Women.

Background: Diabetes mellitus coexists at a greater frequency with hypertension, obesity, central obesity, and dyslipidemia. Obesity has been identified as the most important modifiable risk factor in the aetiology of type-2 diabetes mellitus. Central obesity has been shown to be the most pathogenically important in the causation of metabolic disorders including type-2 diabetes. Aims: To determine the association of central obesity with type 2 diabetes in Bangladeshi women. Subjects and Methods: A total of 60 type 2 diabetic female subjects along with 60 healthy female subjects were recruited in this study. Anthropometric indices were measured using standard techniques. Serum glucose was measured using glucose-oxidase method, insulin was measured using ELISA and thyroid hormones were measured using chemiluminescence based automated Immulite Auto analyzer (DPC, USA). Insulin secretory capacity and insulin sensitivity were estimated using fasting glucose and fasting insulin by HOMA-CIGMA software. Results: Waist circumference of the control (89±8) subjects was significantly (p=0.046) lower than the diabetic (94±11) subjects. Waist-hip ratio of the control subjects was significantly lower compared to diabetic subjects. Fasting plasma insulin level in control sub-jects (7.6±2.2) was significantly (p=0.009) lower compared to diabetic subjects (11.8±9.8). Plasma lipid profile and thyroid hormone status in control and diabetic subjects were not found significantly different. Insulin secretory capacity (HOMA %B) and insulin sensitivity (HOMA%S) in control subjects (93 ±21, 95±39 respectively) were found to be significantly higher com-pared to diabetic subjects (45±32, 67±42 respectively). In age-adjusted binary logistic regression analysis, waist circumference was found to be significantly associated with diabetes. In multiple linear regression analysis TSH was found to be significantly associated with waist circumference. Conclusion: Waist circumference may be an independent indicator for the development type 2 diabetes in Bangladeshi women which may have influenced by thyroid stimulating hormone (TSH). Key Words: wais

Study of 89 Cases of Peripheral Vascular Disease by CT Angiography.

Objective: The purpose of this study was to observe the morphological pattern by CT angiography and risk factors for development of peripheral vascular disease in Bangladeshi patient suffering from peripheral vascular disease using a multidetector scanner in the evaluation of patients with peripheral vascular disease. Subject and Method: Eighty nine patients with peripheral vascular disease who were referred for evaluation of peripheral vascular disease underwent CT angiography. We scanned patients from the level of the cerebral arteries to the pedal arteries in a single helical scan. CT angiograms were produced using maximum-intensity-projection, multiplanous reformation and reconstructions. Findings were graded according to nine categories: 1, normal (0% stenosis); 2, mild (1-49% stenosis); 3, moderate (50-74% stenosis); 4, severe (>75% stenosis); 5, tortuosity; 6, aneurysm, 7, calcification, 8, Arteriovenous malformation (AVM), and 9, haematoma. Results: We found Most of the patients in our study were male (69 out of 89 patients). The mean age was 54.49 ±18.36 in male and 49.45 ±17.89 for female. Commonest risk factor in our study was hypertension 46.1%, followed by diabetes 30.3%, family history 27% smoking 23.6%, dyslipidaemia13.5%. Stenosis (5.61%) was the predominate lesion followed by haematoma (4.49%), Arterio –venous malformation (4.49%). Abdominal aorta was mostly affected in the studied population (58.43%) followed by Lower limb (37.08%), Carotid (22.47%), Renal (7.87%) and Upper limb arteries (4.49%). Conclusion: CT angiography is a noninvasive technique for the imaging of peripheral vascular disease. Since no data is available from a well designed study in PVD in our country, till then the data obtained from this study can be used in Bangladesh.

Risk factor Analysis and Angiographic Profiles in First 228 Cases Undergone Coronary Angiography in Cardiac Cath Lab of Dhaka Medical College Hospital.

Background: Coronary artery diseases are one of the major challenges faced by cardiologists. Control of certain risk factors for CAD is associated with decrease in mortality and morbidity from myocardial infarction and unstable angina. So, identification and taking appropriate measures for primary and secondary prevention of such risk factors is, therefore, of great importance. This retrospective study was carried at the newly set up cath lab in Dhaka Medical college. Materials and Methods: Total 228 consecutive case undergone diagnostic coronary angiogram from 10th January 2007 to31st January 2009 out of which 194(80%) were male and 34 (20%) were female. In both sexes most of the patients were between 41 to 60 years of age. Risk factors of the patients were evaluated. Results: In females commonest risk factor was Diabetes (58.8%) followed by dyslipidaemia (35.3%). In males commonest risk factor was hypertension (30.9%) followed by smoking (29.9%) and diabetes (28.3%). In males 44.3% patients presented with acute myocardial infarction followed by stable angina (43.3%); but in females stable angina was the commonest presentation (50.0%) followed by myocardial infarction (38.2%).CAG findings revealed that in males 33.5% had double vessel disease 26.8% followed by single vessel 26.8% and multivessel disease 25.3%. In females normal CAG was found in 35.5% followed by double vessel 23.5%, multivessel 20.6% and single vessel 20.6%. On the basis of CAG findings; in males 41.8% patients were recommended for CABG, followed by PTCA & stenting 26.3% and medical therapy 30.0%; where as in females 55.9% were recommended for medical therapy , followed by CABG 32.4% and PTCA & stenting11.8%. Conclusion: The commonest presentation of CAD was 4th and 5th decades in both sexes. Diabetes and dyslipidaemia were more common in females whereas hypertension and smoking were more common in males. Myocardial infarction and stable angina were most common presentation in both sexes though in males myocardial infarction was more common. In males the angiographic severity of CAD was more and they were more subjected for CABG in comparison to females.

Study of 89 Cases of Peripheral Vascular Disease by CT Angiography in a Centre of Bangladesh.

Background: The peripheral arterial disease generally refers to a disorder that obstructs the blood supply to upper and lower extremities, most commonly caused by atherosclerosis. Objective: The purpose of this study was to observe the morphological pattern and risk factors for development of peripheral vascular disease in Bangladeshi patients suffering from peripheral vascular disease by CT angiography using a multidetector scanner. Method: Eighty nine patients with peripheral vascular disease who were referred for evaluation of peripheral vascular disease underwent CT angiography. We scanned patients from the level of the cerebral arteries to the pedal arteries in a single helical scan. CT angiograms were produced using maximum-intensity-projection, multiplanous reformation and reconstructions. Findings were graded according to nine categories: 1, normal (0% stenosis); 2, mild (1-49% stenosis); 3, moderate (50-74% stenosis); 4, severe (>75% stenosis); 5, tortuosity; 6, aneurysm, 7, calcification, 8, Arteriovenous malformation (AVM), and 9, haematoma. Results: We found Most of the patients in our study were male (69 out of 89 patients). The mean age was 54.49 ±18.36 yrs in male and 49.45 ±17.89 yrs for female. Commonest risk factor in our study was hypertension 46.1%, followed by diabetes 30.3%, family history 27%, smoking 23.6%, dyslipidaemia13.5%. Stenosis (5.61%) was the predominate lesion followed by haematoma (4.49%) and arterio–venous malformation (4.49%). Abdominal aorta was mostly affected in the studied population (58.43%) followed by Lower limb (37.08%), Carotid (22.47%), Renal (7.87%) and Upper limb arteries (4.49%). Conclusion: CT angiography is a noninvasive technique for the imaging of peripheral vascular disease. Since no data is available from a well designed study in PVD in our country, till then the data obtained from this study can be used in Bangladesh.

Comparative study of coronary collaterals in diabetic and nondiabetic patients by angiography.

Myocardial ischaemia is known to be significantly related to the development of coronary collaterals, but there are considerable variations in their formation. The nature of this variability is not well understood. Likewise it remains unclear whether diabetes mellitus. DM has any effect on coronary collaterals. The aim of this study was to evaluate the effect of diabetes mellitus on coronary collaterals. This prospective case- control study was done from January to December 2000 in patients undergoing coronary angiography in National Institute of Cardiovascular Diseases (NICVD), Dhaka, who fulfilled the inclusion criteria of having < or = 75% stenosis in at least one coronary artery. The patients with diabetes having CAD without other modifiable major risk factors (hypertension, smoking, dyslipidaemia) were constituted case study group (n=36) and nondiabetic patients having CAD with those risk factors were constituted control group (n=50). Coronary collaterals were graded according to Rentrope scoring system and the collateral score was calculated by summing the Rentrope number of every patient. There was no statistical difference between patients with and without diabetes in clinical characteristics. The mean number of diseased vessel in DM group 2.6+/-0.6 was higher than that in nondiabetic patients (2.1+/-0.8, P>.05). The mean collateral score was 0.5+/-0.6 in DM group and 1.2+/-1.0 in nondiabetic group. These findings suggest that coronary collateral development is significantly poorer in diabetic than on diabetic patients.

Use of Wigglesworth classification for the assessment of perinatal mortality in Bangladesh--a preliminary study.

The Wigglesworth pathophysiological classification was used to analyse perinatal deaths occurring in 5 health centres in Bangladesh. The aims were to assess the feasibility of this classification, to determine the causes of perinatal deaths and thereby to identify the areas in need of intervention. A total of 8058 births were recorded at 5 centres during the period of 11 months from mid-January to mid-December 2001. There were 1069 deaths in the perinatal period. Stillbirths were slightly more frequent (53.5%) than early neonatal deaths (46.5%). Among the stillbirths, fresh stillbirths predominated over normally formed macerated ones at all centers except BIRDEM, where the majority (52.5%) was macerated. The majority (71.6%) of perinatal deaths were in the groups comprising asphyxial conditions (46.8%), conditions associated with immaturity (13.3%), and normally formed macerated stillbirths (NFMSB, 11.5%). In the group, 'other specific conditions' which was responsible for 9.3% of perinatal deaths, all but one case was attributed to sepsis. When the cases were subdivided by birth groups, asphyxia predominated in all but the <1000g group, in whom immaturity was responsible. Conditions associated with immaturity were second highest in number. The majority of the perinatal deaths (83.4%) was in babies less than 2500g. The study has shown that the Wigglesworth classification can be used in different types of health facilities in Bangladesh by doctors, nurses and midwives. The areas which need intervention are antepartum care, obstetric and newborn care practices, and environmental factors responsible for the high prevalence of prematurity and low birth weight.